PROCEDURES

Bone Grafting

Major and Minor bone grafting

Over a period of time, the jawbone associated with missing teeth tends to atrophy or is resorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.

Today, we have the ability to improve bone volume where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.

Major Bone Grafting

Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. Other defects may arise as the result of traumatic injuries, cysts, tumors, or congenital defects. The bone is either obtained from a tissue bank or from the patient’s own bone. This bone is harvested from a number of different sites depending on the size of the defect. The chin, lower jaw, skull (cranium), hip (iliac crest), and lateral knee (tibia) are common donor sites. Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft. These membranes are used to encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration. Many bone grafts can be preformed in the office, while more extensive bone grafts must be done in an operating room setting and require a hospital stay.

Sinus lift procedure

The maxillary sinuses are air-filled cavities behind your cheeks and above the upper posterior teeth. Occasionally the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.

When insufficient bone is present, a sinus graft (also called sinus augmentation or sinus lift) is necessary. Drs. Jackson, Heise, and Alpha enter the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new bone.

The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.

Occasionally, sinus augmentations and implant placement can sometimes be performed as a single procedure. This requires enough bone between the upper jaw ridge and the bottom of the sinus to firmly stabilize the implant. However, often there is not enough bone available to stabilize the implant and the sinus augmentation will have to be performed first. This graft will need to mature for several months. Once the graft has matured, the implants can be placed.

Ridge Expansion

In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.

Nerve Repositioning

The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants to the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and 2nd premolar, with the above-mentioned secondary condition.

Typically, a window in the bone is made in the lower jawbone in order to expose the nerve and vessel canal. Then we isolate the nerve and vessel bundle in that area, and slightly pull it out to the side. At the same time, we will place the implants. Then the bundle is released and placed back over the implants.

These surgeries are often performed in a hospital setting under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.